Background: Lyme disease, (LD) is the most common tick-born disease. It is caused by borrelia burgdorferi. Lyme disease is a systemic illness. It can involve different organs, causing a large variety of clinical manifestations. LD is potentially lethal in chronic and late stages, so it is important to consider the antibiotic therapy at Early stages. Cases Report: Here we present a 29-year-old young woman who was admitted to the hospital with fatigue. She claimed to be bitten one day before the admission. She was otherwise a healthy individual. Conclusion: Through this reported case, we highly recommend the Early clinical diagnosis of Lyme disease in endemic areas.

Neuropsychological studies have demonstrated that preclinical dementia accompanies a decreasing trend in cognitive state a few years prior to clinical diagnosis. Sudden decline in episodic memory and semantic knowledge have been found to have the capability to differentiate patients in preclinical state of dementia from those experiencing normal aging. In addition, decline in episodic memory is usually the earliest cognitive change that occurs prior to the development of clinical dementia syndrome. Asymmetry in cognitive abilities may also occur in this preclinical phase of the disease and predict imminent dementia. This review summarizes the contributions of neuropsychological assessment in Early diagnosis of dementia.

Rheumatoid arthritis (RA) is an inflammatory progressive disease which in the absence of appropriate treatment can lead to joint destruction and disability. Prognosis of RA may be predicted based on the presence of some clinical and laboratory evidences. New criteria for classification of RA provides opportunity for earlier treatment. Initiation of treatment particularly by combination of DMARDs concurrent with short duration of corticosteroid is expected to prevent progressive course and even change the natural course of RA. At present any patients with clinical synovitis in at least one joint may have definite RA, requiring aggressive treatment.

Introduction: Conjoined twins are complicated and unusual form of monozygotic twins. We present Early prenatal diagnosis of three cases of conjoined twins by 2-dimensional (2D) ultrasound between 9-10 weeks of gestation.Case presentation: In the first case, we prenatally diagnosed parapagus dicephalus dibrachus dipus with 2- dimensional ultrasound at gestational age of 10 weeks 4 days. In the second case, we detected parapagus dicephalus at the 10 weeks 2 days gestation. In the third case, we diagnosed thoracopagus at the 9 weeks 6 days of gestation, using 2D ultrasound. After proper counselling, all of the patients opted Early pregnancy termination due to the poor prognosis of conjoined twins.Conclusion: Early prenatal detection of conjoined twinning is important for the gestational course. Conjoined twinning could be identified in Early first trimester with cautious and comprehensive view by experienced sonographers. Early and accurate prenatal diagnosis of conjoined twinning allows preferable counselling of the parents and gives a chance for Early termination of pregnancy.

Background: Perinatal asphyxia is an important cause of mortality and permanent neurological and developmental deficit. Early and accurate diagnosis would help to establish the likely prognosis and may also help in determining the most appropriate treatment. Studies in experimental animal models suggest that a protein called Hsp70 may be a good and potentially useful marker of cellular stress that may be clinically useful in determining the presence of neonatal asphyxia.Objectives: Regarding the importance of Early and accurate diagnosis of asphyxia, we conducted this study, which is the first investigation of the comparison of the serum Hsp70 antigen level between asphyxiated and healthy infants.Patients and Methods: In this observational study, the serum concentrations of Hsp70 antigen were compared between neonates suffering from perinatal asphyxia (n=50) and normal neonates (n=51). The inclusion criteria for the cases were neonates who had reached term and had at least two clinical criteria of asphyxia. Exclusion criteria were babies with gestational age<37 weeks, infants with congenital abnormalities or positive blood culture. Exclusion criteria in this group were the requirement to hospital stay during first week of the life or babies whose mothers had difficulties during pregnancy or delivery. Term neonates without major anomalies who had asphyxia during delivery were enrolled in the first six hours after delivery, and control group consisted of healthy term neonates without problems and normal delivery process in the first week of life. The cord blood was taken during labor to measure Hsp70 antigen level by using an in-house ELISA (The enzyme-linked immunosorbent assay).Results: The median values of serum anti Hsp70 titers were significantly higher in asphyxiated neonates compared with non-asphyxiated neonates (0.36 [0.04 - 1.14] vs 0.24 [0.01 - 0.63]). At cutoff point=0.3125 ng/mL, sensitivity was 58% and specificity 76% based on ROC curve.Conclusions: A significant difference between the serum concentrations of Hsp70 of the control and patient group was observed in this study. It is inferred serum concentrations of Hsp70 antigen may be a useful marker for the Early diagnosis of that prenatal hypoxia.

Objective As acute liver failure (ALF) and chronic liver disease (cirrhosis) continue to increase in prevalence, we will see more cases of hepatic encephalopathy.Primary care physician are often the first to suspect it, since they are familiar with the patient’s usual physical and mental status. This serious complication typically occurs in patients with severe comorbidities and needs multidisciplinary evaluation and care.Hepatic encephalopathy should be considered in any patient with acute liver failure and cirrhosis who presents with neuropsychiatric manifestations, decrease level of consciousness (coma), change of personality, intellectual and behavioral deterioration, speech and motor dysfunction.Every cirrhotic patient may be at risk; potential precipitating factors should be addressed in regular clinic visits. The encephalopathy of liver disease may be prominent, or can be present in subtle forms, such as decline of school performance, emotional outbursts, or depression.“Subtle form” of hepatic encephalopathy may not be obvious on clinical examination, but can be detected by neurophysiologic and neuropsychiatric testing.